By 2050, WHO smoking controls could prevent 13 million deaths in China

A report in the BMJ finds that if China implements World Health Organization guidelines on smoking, then almost 13 million smoking-related deaths will be avoided by 2050.

China is the most populated nation in the world and accounts for about a third of the world's smokers - more than half of all Chinese men smoke. China's largely government-owned tobacco industry is also the world's biggest producer of tobacco.

But a reduction of smoking in China would have a huge impact on global public health.

China joined the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) in 2003, but only partially implemented the FCTC tobacco control policies. The control policies include:

Surveillance and monitoring of the prevalence of tobacco use

Creation of smoke-free environments

Treatment of tobacco dependence

Taxation on tobacco consumption and other price controls

Enforcement of health warnings on tobacco packages

Marketing bans.

Despite increasing their tax on tobacco products, there was no rise in retail price for Chinese tobacco, with the price increase being absorbed at wholesale level instead.

And although a smoking ban on public transportation was implemented, the government did not attempt any other control of smoking in public places. A 2011 WHO report identified multiple areas for improved implementation of the FCTC in China.

To examine the potential effects of full implementation of the FCTC policies in China, the researchers used a simulation programmed in Microsoft Excel called SimSmoke.

Data on Chinese fertility and mortality from the United Nations Population Division was fed into the simulation to provide projected population figures.

The researchers think that the model provided accurate projections based on their data, but they were unable to access modern Chinese data on initiation and cessation rates - when people start and quit smoking - so they based the cessation and initiation rates on available research from the 1990s.

What would happen if China implemented the FCTC policies?

The simulation found that, under current policies, a total of 50 million smoking-related deaths would occur between 2012 and 2050.

The researchers report that increasing cigarette taxes to 75% of the retail price would cut smoking prevalence by 13% for men and 12% for women by 2050. The tax increase on its own is estimated to save 3.5 million lives, and the study considers this to be the most effective policy in deterring people from smoking.

Enforcing smoke-free air laws would lead to a 10% decline in smoking rates and prevent 3.4 million deaths by 2050. The researchers think this will be the second most effective policy.

The researchers also believe that a marketing ban would reduce smoking prevalence by about 4% and cause 2 million potential deaths to be averted.

The study notes that a 2010 survey "found that many Chinese are largely unaware of the adverse health effects of smoking." The researchers explain that, "as was the case years ago in other nations that evolved through the phases of the tobacco epidemic, cigarette smoking is currently ingrained in Chinese cultural practices."

The model found that if the entire WHO guidelines were implemented successfully, then by 2050 smoking prevalence would drop by 40%, almost 13 million smoking-related deaths would be averted and a total of more than 154 million life years would be gained in China.

A recent WHO report found that the FCTC program would be cost effective for China. The researchers behind the BMJ study concur, adding that "without the implementation of the complete set of stronger policies, the death and disability legacy of current smoking will endure for decades in China."

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